Transcript SUBSTANCE ABUSE by

SUBSTANCE ABUSE
by
Dr. C. S. Umeh
Consultant Clinical Psychologist
LUTH
Concept of Substance Abuse
• Substance abuse is what the lay person
calls drug abuse. In both ICD -10 and
DSM – IV, substance abuse was preferred
because not all substances that are
abused are necessarily drugs eg inhalants
• However drug abuse is more popular
Concept contn’d
• A few authors have gone further to use the
terms, Alcohol, Tobacco and other drugs
Abuse (ATODA) in order to reflect the fact
that the use of tobacco products is as
harmful to health as the more popular
drugs of abuse.
• In 1969, WHO defined a drug as any
substance when taken into the body may
modify one or more of its functions.
Concept contn’d
• Since many substances can do this
without affecting the psychological
functioning of the individual, the term
psychoactive substances were then used
to categorize this group of substances
which are capable of producing
psychological effects such as the
alteration of moods, perception and
consciousness
Development of Substance
Dependence behaviour
• Substance dependence behavior develops
gradually over a long time. Three factors
influence the rate of development:
• The type of substance
• The dosage
• The frequency of use
Development Contn’d
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The combined effect produce dependence
through the following:
Substance use
Substance misuse
Substance abuse
Craving
Tolerance
Psychological dependence (Habituation)
Physiological dependence (Drug addiction)
Withdrawal syndrome (Abstinence syndrome)
Other Features of Substance
abuse
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Flashback
Bad Trip
Blackout
Substance – induced psychosis
CLASSES AND EFFECTS OF
PSYCHOACTIVE SUBSTANCES
• The effects of any psychoactive substance
depends upon
– the class or category to which it belongs,
– the quantity used at a time and
– the frequency of use.
• However, each class of psychoactive
substances has distinctive
psychopharmacological properties.
CLASSES AND EFFECTS
CONTN’D
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The classes are:
DEPRESSANTS
STIMULANTS
HALLUCINOGENS
INHALANTS
DESIGNER SUBSTANCES
ANABOLIC STEROIDS
DEPRESSANTS
• These are substances which slow down or
reduce the rate of functioning of the body organs
and systems. The rate of slowing down
depends on the sub-category the substance
belongs. The common sub-categories are
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alcohol,
narcotics,eg opium, codeine, heroine, morphine
barbiturates,eg phenolbarbitone andAmylobarbitone
minor tranquilizers eg benzodiazepine and diazepam
major tranquilizers.eg chlopromazine (largactil
STIMULANTS
• These are substances which promote
wakefulness, increase body activities, induce
mental alertness and generally increase
heartbeat. Subcategories of stimulants are:
• cocaine,
• amphetamines,eg
Benzedrine,Dextroamphetamine (dexedrin)
methylphenidate (Ritalin)
• caffeine,
• nicotine and
• anti depressants
HALLUCINOGENS
• These are substances popularity called
mind benders, psychedelic drugs or
psychotomimetics. They produce radical
changes in the mind of users. Some
changes include vivid imagery,
hallucinations, distortion of awareness and
displacement of reality. Categories of
hallucinogens are :
HALLUCINOGENS Contn’d
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CANNABISL S D – ( Lysergic acid diethylamide)
PSILOCYBIN
MESCALINE
PCP (PHENCYCLIDINE) (Angel dust)
INHALANTS.
• These are commonly available commercial
products eg include petrol, glue, shoe polish,
nail vanish, aerosols and floor wax. Related
substances are the synthetic substance
otherwise called designer drugs. They are
manufactured in the labs as isotopes or
derivatives of other substances. The effect of
both inhalants and designers drugs are similar to
the combined effects of stimulants and
hallucinogens
ANABOLIC STEROIDS
• These are substances which are used
essentially to enhance performance in
sports. Most of them are derivatives of the
hormone-testosterone. They therefore
have very powerful effects in influencing
the hormonal activities of the body.
Essentially, anabolic steroids are used to
build muscles and to enhance the
individuals stamina.
DSM Classification
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There are 4 substance related conditions
recognized by DSM-IV. They are:
Substance intoxication
Substance withdrawal
Substance abuse
Substance dependence
Substance intoxication
• maladaptive behavioral or psychological
changes directly resulting from the
physiologic effects on the central nervous
system of recent ingestion of or exposure
to a psychoactive substance, particularly
alcohol.
Substance withdrawal
• Experience of clinically significant distress
in social, occupational or other areas of
functioning due to the cessation or
reduction of substance use. It can begin a
few hours after cessation and could last
for weeks.eg tremor, craving, seizure,
sleep disturbances, fatigue, nausea,
hallucination, anxiety, etc.
Substance abuse
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One or more of the following occurs during a 12
month period leading to significant distress:
Failure to fulfill important obligations at work,
home or school due to substance use.
Repeated use of substance in hazardous
situations
Repeated legal problem due to use.
Continued use of substance despite repeated
legal or social problems
Substance dependence
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Three or more of the following:
Tolerance
Withdrawal
Substance taken for a longer time or greater
amount than intended
Desire or effort to reduce or control use
Much time spent in activities to obtain it
Given up occupational or recreational activities
Use continued despite knowing worsening
psych and physical problems.
ASSESSMENT
• Clinical interview
• Psychological tests
• Urine and blood screening tests
Cage questionnaire (Ewing,1984)
1. Have you ever felt you should cut down on your
drinking?
Yes No
2. Have people annoyed you by criticising your drinking?
Yes No
3. Have you ever felt bad or guilty about your drinking?
Yes
No
4. Have you ever had a drink first thing in the morning to
steady your nerves or get rid of a hangover (eyeopener)?
Yes
No
MANAGEMENT
• Assessing for level of motivation for change.
• There is a model for change. It comprises
Stage 1: Precontemplation - the client is not yet
considering change or is unwilling to change
Stage 2: Contemplation – the client acknowledges
concernsand is considering the possibility of
change but is ambivalent and uncertain
Management contn’d
Stage 3: Preparation – the client is
commited to and is planning to make a
change in the near future but is still
considering what to do
Stage 4: action: the client is actively taking
steps to change but has not yet reached a
stable state
Management contn’d
Stage 5: maintenance – The client has
achieved initial goals such as abstinence
and is now working to maintain gains
Stage 6: the client has experienced a
recurrence of symptoms and must now
cope with consequences and decide what
to do next.
Management contn’d
• Detoxification
• Psychotherapy
• Rehabilitation
• Thank you for your attention